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Background: Sepsis is one of the leading causes of mortality in children under 5 years by UNICEF statistics which is difficult to diagnose because of nonspecific initial clinical presentation and potential for rapid deterioration. In this regard use of Yale Observation Scale assists in early recognition of serious bacterial infection than other laboratory investigation as it is simple, quick, easy to apply and cost-effective bed side scale.Methods: All eligible young febrile infants and children were consecutively enrolled in the study. Axillary temperatures of the cases were documented. Yale observation scoring was done. Blood sample were sent for culture and sensitivity. Colonies were identified morphologically by Gram stain and biochemically. The collected data was analyzed using ROC curve for finding cut off scores of Yale Observation Scale for prediction of severe bacterial illness and final outcome. Statistical analysis was performed using the Statistical Packages for Social Sciences (SPSS) version 14 for MS Window.Results: Bacteremia was found in 23(15.3%) out of total 150 young febrile children enrolled in the present study. It shows that in lower YOS score blood culture was sterile and in higher YOS score blood culture was positive for bacteremia, which is statistically significant with p value (<0.05). As per ROC curve analyses the best cut off value of YOS for prediction of bacteremia was 17.5 with sensitivity 91.3%, specificity 81.9%, PPV 47.7% and NPV of 98.1%.Conclusions: YOS of '>17.5 has a good predictive ability for prediction of bacteraemia in young febrile children.
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Background: The Yale observation scale (YOS) is an illness severity helps to diagnose bacteremia based on simple noninvasive clinical signs and symptoms. The aim of the present study was to assess the utility of YOS as a predictor of bacterial infection in febrile children aged 3 to 36 months.Methods: This prospective observational study was conducted on 200 children aged 3 to 36 months presenting with fever, at the Institute of Child Health and Hospital for Children during the period from April 2016 to September 2016. Rectal temperature was taken for all children. Clinical examination was done as required based on the YOS and scores were given accordingly at the time of initial presentation of the child before invasive investigations. All the observation was assessed statistically and receiver operating characteristics (ROC) curve was performed to analyze the sensitivity of the YOS.Results: Highly significant correlation (p=0.0001) was found to exist between the age of the child, duration of the fever, higher body temperature >104, WBC count, ANC and improved condition of patient with higher YOS. ROC curves showed that the sensitivity and specificity of YOS at the best cut off value of 14.5 was found to be 97% and 79.6% respectively.Conclusions: YOS is very good tool for predicting bacteremia in young febrile children based on simple non-invasive clinical signs and symptoms. The findings ruled out by YOS aids in the immediate and early management of bacterial infections before the arrival of the results of the biochemical diagnostic tests.
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Objective. To assess the accuracy and reliability of yale observation scale (YOS) predicting bacteremia. Methods. 219 consecutive febrile inpatients aged 3-36 months were the subjects. Before giving antipyretics, rectal temperature was recorded. YOS scores were assessed by 2 independent blinded residents. History, clinical examination and investigations followed. Blood cultures were taken in all children before antibiotics. Point estimates and 95% confidence intervals were calculated for sensitivity, specificity, positive & negative predictive values and likelihood ratios for use of YOS as a diagnostic test in prediction of bacteremia. The best cut off value for a positive YOS test was established by calculating these statistical values separately for a cut off YOS score of 8, 10 and 12 and plotting ROC curve. Reliability of YOS was assessed by the inter-observer agreement through kappa statistics. Results. Study population (n=219) had 59.36% males and a mean age of 15.24 months. 28.16% subjects had bacteremia. Mean YOS scores were significantly higher in bacteremic children (14.9 vs 8.78 in non-bacteremic, p=0.00001) Sensitivity, specificity, PPV, NPV, LR+ and LR- of YOS score >10 to predict bacteremia were 87.93%, 83.78%, 68.00%, 94.66%, 5.42 and 0.14 respectively. Those of YOS score >8 were 96.55%, 65.54%, 52.34%, 97.98%, 2.80 and 0.05 respectively and of a YOS score >12 were 48.28%, 91.22%, 68.29%, 81.82%, 5.5 and 0.5 respectively. ROC curve showed YOS score >10 to be the best cut off for prediction of bacteremia. Area under ROC curve was 0.9001. The chance corrected inter-observer agreement (kappa) was 0.7919. Conclusion. YOS is a simple, easy to administer, cost-effective and useful test to predict bacteremia in a febrile child aged 3-36 months due to its high sensitivity and reproducibility.